Cohousing-L Mailing List: Re: Insurance-free healthcare

[Martin Sheehy (martinsheehy]

" Fragmented Care ". How true. The right-hand doctor/hospital does not know 
what the left-hand doctor/facility is doing. Sad and a problem unto itself if 
only because of duplicaton of services--blood-work X-rays MRIs etc. and the 
inconvience attached to dealing with doctors' offices & hospitals-facilities.
   
  Another obstacle is: Many (  <62-65 y/o) carry health'care' insurance 
courtesy of our employer ( not always selected in our/employees' best 
interests) and the plans vary widely--HMOs, PPOs, POS, PIS ( just kiddin' :-), 
Aetna, United Health'care', CIGNA, Blue Cross/Shield etc. and many doctors may 
not be members of ALL such plans, so a doctor attending upon residents of a 
CoHousing Community ( & who, given the nature of the communities, i.e. 
relatively new residents from other areas of the Nation with plans the local 
doctor has never even heard of. And, if your plan isn't " good " [ for the 
doctor] he/she may not wish you as a patient.
  Fragmented?. I'll say.
  ( Dr.) Marty.

Saramandaia Farm <etaincr [at] yahoo.com> wrote:
  I've had a private practice that was basically fee-for-service. I practiced 
in the Fort Lauderdale area, and didn't accept insurance because I didn't want 
to do the paperwork/dealing with jerks it required, and because I did home 
births, which were generally not covered by insurers or HMOs...there were 
exceptions. I also had seen that health insurance coverage frequently changed 
depending on things like who was the lowest bidder (great, eh?), or which union 
official accepted which bribe from which HMO to secure the contract for the 
large employers...often teachers unions or postal workers, or some such. This 
left people distraught at having to change docs...often in mid-pregnancy or 
mid-chemotherapy... and fragmented care. So we were a cash practice and we 
helped patients with their insurance forms...I had an office managers whose 
work that was. I had ~2,500 active charts, and saw 15-20 patients a day in 
about 8 hours. I did and do make
house-calls...can't really attend home births otherwise. I don't maintain an 
office in Costa Rica, in fact...I work from my home or theirs. But even 
comparing the two places and their different cultural and governmental issues 
is pretty much impossible. We have a national health system here, which 
everyone can use. And no one here would come to a doctor for a 
less-than-serious complaint. US docs spend much of their time and waste their 
specific medical skills on the worried well.

The point is not turning turning co-housing into assisted care...the original 
question was whether access to on-site health care access would be attractive 
to prospective residents, I think. Family docs, at least, treat families. Young 
and older members. Gerontologists or, really, geriatricians, deal almost 
exclusively with the problems of older people...often thought of as Medicare 
age and older. 

Issues like choice of care-givers, ancillary services, available social 
services...all those are kind of separate. I think it would depend on what the 
community decided to invest its energy in...on-site doc, on-site mid-level 
(P.A., N.P.), on-site help with insurance paperwork, on-site phlebotomy 
(blood-drawing), transportation to off-site resources. The list is long. And 
every community would and does handle it in a different way. Here in Costa 
Rica, every town or village has a "health unit", where routine stuff is 
done...well-baby care, immunizations, monthly glucose testing for diabetics, BP 
readings for hypertensives, Pap smears, sometimes prenantal visits, and 
immediate care not requiring transport to a hospital. Saves everyone (most of 
the people here don't have cars) a trip to facilities half an hour or more 
away. Emergencies, serious health problems, and complications of pregnancy or 
labor are dealt with at the national hospitals. The nurses
and docs at the village/town level pretty much know the patients...they're 
neighbors. Works for here...might not everywhere.

>From a doctor's standpoint, more problematic would be malpractice insurance (I 
>didn't carry any in Florida...I was uninsurable anyway because of the home 
>births) and overhead expenses, including staff. I always work with one nurse 
>(often a midwife). In my larger practice, I employed a nurse and an office 
>manager...but that was it. 

It's enjoyable having a somewhat seamless life. My home is my work is my family 
are my friends etc. Sometimes it's a pain in the ass, and more separation 
sounds nice. But those are just my preoccupations, and I really suspect that 
it's not a style that people in the US would warm up to. Everyone seemed always 
to want "the BIGGEST heart man at Columbia Presbytarian", or the CT for 
frequent headaches, or testing for a zillion rare diseases out of worry.

This may be more than anyone wants to hear, but, hell, chairs and acoustics 
aren't too interesting either.

I should say that I never made much money in private practice:)

Sharon


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